September Update on Health Care Debate

Health care remains atop Washington’s agenda, with the prospects for passage unclear. Despite large majorities in both the House and the Senate, there remains much division within the Democratic Party on what the final legislation should include, and the timeline going forward. Today’s column is an effort to offer an objective update on where things stand in Congress, and what to look for in the weeks ahead.

Health care falls under the jurisdiction of five Congressional committees: House Ways & Means; House Education & Labor; House Energy & Commerce; Senate Health, Education, Labor, & Pensions; and Senate Finance. All but Senate Finance have marked up and passed similar versions of their health care overhauls.

The basic components consistent in all of the bills passed out of committee include the following: the creation of a federally-regulated national health insurance “exchange”; the creation of a public health insurance “option”; the federalization of insurance regulations; a mandate on individuals to purchase health insurance; a mandate on employers to offer health insurance; penalties if you don’t purchase/offer coverage; subsidies/credits for low-income Americans to purchase coverage; an expansion in Medicaid coverage; reductions in Medicare payments; and a range of tax increases to help offset the costs. I have offered more specific details in previous columns at JournalTimes.com and at each of my 17 health care listening sessions held in August (PowerPoint, Video).

Last week, the Senate Finance Committee, chaired by Senator Max Baucus (D-MT), unveiled its proposal. The Baucus bill will follow the same legislative structure with a federal co-op instead of a public option; no specific employer mandate; lowers the level of subsidies; additional changes to Medicare and more in an effort to bring down the price tag. Concerns have been raised that the proposed savings, especially with Medicare cuts for seniors and doctors, would not be sustained and the true costs of the bill would be much larger than advertised. The Senate Finance Committee is expected to begin marking up Senator Baucus’ proposal this week.

The road ahead is fraught with uncertainty. With public support slipping, the Majority is considering the use of a procedural tactic known as “reconciliation.” Reconciliation is a budget tool designed to fast-track deficit reduction measures by limiting debate, cutting off amendments, and preventing a possible “filibuster” by requiring only a simple Majority for passage in the Senate. Concerns have been raised with this partisan, go-it-alone approach in dramatically overhauling our nation’s health care sector. It should be noted that the “reconciliation” process has been misused by both parties in the past – but I would contend that past abuses of this power do not justify future abuses, especially on an issue of such magnitude.

Most Americans – including the thousands that made their voices heard at one of my listening sessions in August – agree that we need to fix what’s broken in health care, but have concerns that the current proposals could break what’s working. I will continue my efforts to promote fiscally-responsible, patient-centered alternatives (http://www.house.gov/ryan/healthcare), and will continue to keep you updated on the latest in the health care debate.